Conceptualization of Pre-frailty and Perspectives on Its Screening and Management among Community-dwelling Older Adults with Pre-frailty: a Semi-Structured Interview Study postprint

Abstract: Background　With the accelerating aging of the population, pre-frailty, as a reversible "golden window of intervention", is crucial for promoting healthy aging. However, there is a lack of in-depth research on how community-dwelling older adults understand and perceive frailty and pre-frailty, and their views on related screening and management. Objective　To explore the conceptualization of pre-frailty and perspectives on its screening and management among community-dwelling older adults with pre-frailty, and to analyze the facilitators and barriers, so as to provide a basis for developing efficient and acceptable early intervention programs. Methods　Based on the capability, opportunity, motivation-behaviour (COM-B) model and the Theoretical Domains Framework (TDF), semi-structured interviews were conducted in August 2025 with 14 community-dwelling older adults identified as pre-frail in previous research. Participants were recruited using purposive sampling and snowball sampling from Xuxinzhuang and Taoranting Community Health Centers in Beijing. Open-ended questions were used to guide participants in describing their understanding of pre-frailty, their willingness to participate in screening and management, and the influencing factors. Directed content analysis was used to collate and analyze the interview data. Results　The study found that while older adults' conceptualization of "pre-frailty" was diverse and limited, they showed a strong willingness to participate in screening and interventions. Their needs were personalized and diverse, including a desire for authoritative knowledge, professional guidance and flexible service models. Facilitators included: sound family/community support, convenient exercise environments, trusting relationships with primary care and intrinsic motivation to reduce burden on children and maintain self-reliance. Barriers included: lack of health knowledge and difficulty in discerning information, uneven distribution of community resources and public services, insufficient trust in primary healthcare services, and behavioral inertia due to lack of confidence among some older adults. Conclusion　There is a significant unmet need and high willingness to participate in screening and management among community-dwelling older adults with pre-frailty. The construction of future intervention strategies requires multi-dimensional collaboration: enhancing cognition and skills through health education (Capability), optimizing the community environment and primary healthcare services to provide resource support (Opportunity), and fully utilizing their intrinsic health motivation to design personalized programs (Motivation). This is of great significance for seizing the intervention window for pre-frailty and advancing the healthy aging strategy.